coordination programme (monthly progress report) 2018 … · the plan with targets ** please...
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Annexure – 9 From NY volunteer to District NYK
COORDINATION PROGRAMME (Monthly Progress Report) 2018-2019
Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.
Name of NY Volunteers …………………………. Name of allotted Block(s)……………………………… Progress Report for the month ……………………………………..
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
Name of collaborating agency / deptts.
No. of place/ village where progs. organized
Name & Designation of VIPs and dignitaries attended prog.**
No. of Days Resource Mobilization Physical Number of participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
1. Linking Youth Club Members with Employable Skill Development Trainings
No. of Youth
2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others
No. of villagers
3. Creation of new Water Bodies No. of Water Bodies
4. Maintenance/ repair/ improvement of existing Water Bodies
No. of water bodies
5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.
Number
6. Maintenance & repair of Cremation Grounds and Play Grounds
Number
7. Recharging / De-silting of Wells Number
8. Water Harvesting in Villages Number
9. Construction of Bori Badas in a Village Number
10. Agriculture Land Soil Cards Number
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
Name of collaborating agency / deptts.
No. of place/ village where progs. organized
Name & Designation of VIPs and dignitaries attended prog.**
No. of Days Resource Mobilization Physical Number of participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
11. Selection of Swachhta Ambassadors at Block, District & State level
No. of Ambassadors
12. Chain of Ambassadors Number
13. Cleanliness of School/College No. of Schools/ Colleges
14. Cleanliness PHC/Sub Center/Hospitals Number
15. Cleanliness Drive to clean streets and common places
Number
16. Cleaning of office complex, toilets and garbage places of district & state offices
Number
17. Cleanliness Public Statues Number
18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)
No. of Toilets
19. Sapling Plantation and their survival No. of Plants
20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment
No. of Villages
21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages
No. of Villages
22. Blood Donation No. of Youth donated blood
23. Enrollment of Voluntary Blood Donors and their Blood Grouping
No. of Youth
24. Providing access of Iron Folic Acid Tablet to Adolescent Girls
No. of Adolescent Girls
25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.
No. of Girls
26. Motivate and Facilitated Institutionalized Deliveries
No. of Women
27. Immunization of Pregnant Mothers No. of Pregnant Mothers
28. Motivate and Immunization of Children (0-5 yrs)
No. of Children
29. Cataract (Eye) operations No. of Persons
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
Name of collaborating agency / deptts.
No. of place/ village where progs. organized
Name & Designation of VIPs and dignitaries attended prog.**
No. of Days Resource Mobilization Physical Number of participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)
No. of Camps
31. Enrollment of children in schools No. of Children
32. Beti Bachao - Beti Padhao Number
33. Facilitating into getting Voters ID Cards No. of Persons
34. Training in Cashless Transaction to Youth Leaders
No. of Persons
35. Other Programmes as per local need and priority may please be added in the Plan with targets
** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct
Signature
NY volunteer with Office Stamp
Name:……………………………..
Block:……………………………..
Note : Please use the same proforma. Date :……………………………...
Annexure – 9 A
From District NYK to State Office
COORDINATION PROGRAMME (Monthly Progress Report) 2018-2019
Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.
Name of District Youth Coordinator ………………No. of Blocks in the District………………No. of NY Volunteers………………………….Progress Report for the month ………………………
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
Name of collaborating agency / deptts.
No. of place/ village where prog. organized
Name & Designation of VIPs and dignitaries attended prog.**
No. of Days Resource Mobilization Physical Number of participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
1. Linking Youth Club Members with Employable Skill Development Trainings
No. of Youth
2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others
No. of villagers
3. Creation of new Water Bodies No. of Water Bodies
4. Maintenance/ repair/improvement of
existing Water Bodies
No. of water bodies
5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.
Number
6. Maintenance & repair of Cremation Grounds and Play Grounds
Number
7. Recharging / De-silting of Wells Number
8. Water Harvesting in Villages Number
9. Construction of Bori Badas in a Village
Number
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
Name of collaborating agency / deptts.
No. of place/ village where prog. organized
Name & Designation of VIPs and dignitaries attended prog.**
No. of Days Resource Mobilization Physical Number of participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
10. Agriculture Land Soil Cards Number
11. Selection of Swachhta Ambassadors at Block, District & State level
No. of Ambassadors
12. Chain of Ambassadors Number
13. Cleanliness of School/College No. of Schools/ Colleges
14. Cleanliness PHC/Sub Center/Hospitals
Number
15. Cleanliness Drive to clean streets and common places
Number
16. Cleaning of office complex, toilets and garbage places of district & state offices
Number
17. Cleanliness Public Statues Number
18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)
No. of Toilets
19. Sapling Plantation and their survival No. of Plants
20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment
No. of Villages
21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages
No. of Villages
22. Blood Donation No. of Youth donated blood
23. Enrollment of Voluntary Blood Donors and their Blood Grouping
No. of Youth
24. Providing access of Iron Folic Acid Tablet to Adolescent Girls
No. of Adolescent Girls
25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.
No. of Girls
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
Name of collaborating agency / deptts.
No. of place/ village where prog. organized
Name & Designation of VIPs and dignitaries attended prog.**
No. of Days Resource Mobilization Physical Number of participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
26. Motivate and Facilitated Institutionalized Deliveries
No. of Women
27. Immunization of Pregnant Mothers No. of Pregnant Mothers
28. Motivate and Immunization of Children (0-5 yrs)
No. of Children
29. Cataract (Eye) operations No. of Persons
30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)
No. of Camps
31. Enrollment of children in schools
No. of Children
32. Beti Bachao - Beti Padhao Number
33. Facilitating into getting Voters ID Cards
No. of Persons
34. Training in Cashless Transaction to Youth Leaders
No. of Persons
35. Other Programmes as per local need and priority may please be added in the Plan with targets
** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct
Note : Please use the same proforma. Signature
Name:……………………………….
District Youth Coordinator with Office Stamp Prepared by ACT: Name and Signature ……………………………………………
Date ________________________ Date:………………………………..
Annexure – 9 B From District NYK to State Office
COORDINATION PROGRAMME (Cumulative Progress Report) 2018-2019
Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.
Name of District Youth Coordinator …………………………. No. of Blocks in the District………………No. of NY Volunteers…………………Progress Report for the Period …………………
S.No. Name of the prog. organized Prog. Unit No. of
Youth Clubs involved
No. of place/ village where progs. organized
No. of Days
Name of collaborating agency / deptts.
Name & Designation of VIPs and dignitaries attended prog.**
Resource Mobilization Physical Number of participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
1. Linking Youth Club Members with Employable Skill Development Trainings
No. of Youth
2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others
No. of villagers
3. Creation of new Water Bodies No. of Water Bodies
4. Maintenance/ repair/improvement of existing Water Bodies
No. of water bodies
5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.
Number
6. Maintenance & repair of Cremation Grounds and Play Grounds
Number
7. Recharging / De-silting of Wells Number
8. Water Harvesting in Villages Number
9. Construction of Bori Badas in a Village
Number
10. Agriculture Land Soil Cards Number
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
No. of place/ village where progs. organized
No. of Days
Name of collaborating agency / deptts.
Name & Designation of VIPs and dignitaries attended prog.**
Resource Mobilization Physical Number of participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
11. Selection of Swachhta Ambassadors at Block, District & State level
No. of Ambassadors
12. Chain of Ambassadors Number
13. Cleanliness of School/College No. of Schools/ Colleges
14. Cleanliness PHC/Sub Center/Hospitals
Number
15. Cleanliness Drive to clean streets and common places
Number
16. Cleaning of office complex, toilets and garbage places of district & state offices
Number
17. Cleanliness Public Statues Number
18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)
No. of Toilets
19. Sapling Plantation and their survival No. of Plants
20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment
No. of Villages
21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages
No. of Villages
22. Blood Donation No. of Youth donated blood
23. Enrollment of Voluntary Blood Donors and their Blood Grouping
No. of Youth
24. Providing access of Iron Folic Acid Tablet to Adolescent Girls
No. of Adolescent Girls
25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.
No. of Girls
26. Motivate and Facilitated Institutionalized Deliveries
No. of Women
27. Immunization of Pregnant Mothers No. of Pregnant Mothers
28. Motivate and Immunization of Children (0-5 yrs)
No. of Children
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
No. of place/ village where progs. organized
No. of Days
Name of collaborating agency / deptts.
Name & Designation of VIPs and dignitaries attended prog.**
Resource Mobilization Physical Number of participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
29. Cataract (Eye) operations No. of Persons
30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)
No. of Camps
31. Enrollment of children in schools No. of Children
32. Beti Bachao - Beti Padhao Number
33. Facilitating into getting Voters ID Cards
No. of Persons
34. Training in Cashless Transaction to Youth Leaders
No. of Persons
35. Other Programmes as per local need and priority may please be added in the Plan with targets
** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct
Note : Please use the same proforma. Signature
Name:………………………………
District Youth Coordinator with Office Stamp Prepared by ACT: Name and Signature ……………………………………………
Date ________________________ Date:…………………………………….
Annexure – 9 C From State Office to NYKS, Hqr.
COORDINATION PROGRAMME (Monthly Progress Report) 2018-2019
Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.
Name of State Director …………………………..No. of District NYKs……………No. of Blocks……………….No. of NY Volunteers…………Progress Report for the month ………………………
S.No. Name of the Prog. organized Prog. Unit No. of
Youth Clubs involved
No. of place/ village where progs. organized
No. of Days Name of collaborating agency / deptts.
Name & Designation of VIPs and dignitaries attended prog.**
Resource Mobilization Physical Number of Participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
1. Linking Youth Club Members with Employable Skill Development Trainings
No. of Youth
2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others
No. of villagers
3. Creation of new Water Bodies No. of Water Bodies
4. Maintenance/ repair/improvement of existing Water Bodies
No. of water bodies
5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.
Number
6. Maintenance & repair of Cremation Grounds and Play Grounds
Number
7. Recharging / De-silting of Wells Number
S.No. Name of the Prog. organized Prog. Unit No. of Youth Clubs involved
No. of place/ village where progs. organized
No. of Days Name of collaborating agency / deptts.
Name & Designation of VIPs and dignitaries attended prog.**
Resource Mobilization Physical Number of Participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
8. Water Harvesting in Villages Number
9. Construction of Bori Badas in a Village
Number
10. Agriculture Land Soil Cards Number
11. Selection of Swachhta Ambassadors at Block, District & State level
No. of Ambassadors
12. Chain of Ambassadors Number
13. Cleanliness of School/College No. of Schools/ Colleges
14. Cleanliness PHC/Sub Center/Hospitals
Number
15. Cleanliness Drive to clean streets and common places
Number
16. Cleaning of office complex, toilets and garbage places of district & state offices
Number
17. Cleanliness Public Statues Number
18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)
No. of Toilets
19. Sapling Plantation and their survival No. of Plants
20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment
No. of Villages
21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages
No. of Villages
22. Blood Donation No. of Youth donated blood
23. Enrollment of Voluntary Blood Donors and their Blood Grouping
No. of Youth
24. Providing access of Iron Folic Acid Tablet to Adolescent Girls
No. of Adolescent Girls
25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.
No. of Girls
26. Motivate and Facilitated Institutionalized Deliveries
No. of Women
S.No. Name of the Prog. organized Prog. Unit No. of Youth Clubs involved
No. of place/ village where progs. organized
No. of Days Name of collaborating agency / deptts.
Name & Designation of VIPs and dignitaries attended prog.**
Resource Mobilization Physical Number of Participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
27. Immunization of Pregnant Mothers No. of Pregnant Mothers
28. Motivate and Immunization of Children (0-5 yrs)
No. of Children
29. Cataract (Eye) operations No. of Persons
30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)
No. of Camps
31. Enrollment of children in schools No. of Children
32. Beti Bachao - Beti Padhao Number
33. Facilitating into getting Voters ID Cards
No. of Persons
34. Training in Cashless Transaction to Youth Leaders
No. of Persons
35. Other Programmes as per local need and priority may please be added in the Plan with targets
** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct Note : Please use the same proforma. Signature
Name:………………………………
State Director with Office Stamp
Date:………………………………..
Prepared by Dealing Hand: Name & Signature ………………………………………
Date ________________________
Annexure – 9 D
From State Office to NYKS, Hqr.
COORDINATION PROGRAMME (Cumulative Progress Report) 2018-2019
Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.
Name of State Director ………………………No. of District NYKs………………No. of Blocks………………No. of NY Volunteers…………………Progress Report for the Period ……………………
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
No. of place/ village where progs. organized
No. of Days Name of collaborating agency / deptts.
Name & Designation of VIPs and dignitaries attended prog.**
Resource Mobilization Physical Number of Participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
1. Linking Youth Club Members with Employable Skill Development Trainings
No. of Youth
2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others
No. of villagers
3. Creation of new Water Bodies No. of Water Bodies
4. Maintenance/ repair/improvement of
existing Water Bodies
No. of water bodies
5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.
Number
6. Maintenance & repair of Cremation Grounds and Play Grounds
Number
7. Recharging / De-silting of Wells Number
8. Water Harvesting in Villages Number
9. Construction of Bori Badas in a Village
Number
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
No. of place/ village where progs. organized
No. of Days Name of collaborating agency / deptts.
Name & Designation of VIPs and dignitaries attended prog.**
Resource Mobilization Physical Number of Participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
10. Agriculture Land Soil Cards Number
11. Selection of Swachhta Ambassadors at Block, District & State level
No. of Ambassadors
12. Chain of Ambassadors Number
13. Cleanliness of School/College No. of Schools/ Colleges
14. Cleanliness PHC/Sub Center/Hospitals
Number
15. Cleanliness Drive to clean streets and common places
Number
16. Cleaning of office complex, toilets and garbage places of district & state offices
Number
17. Cleanliness Public Statues Number
18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)
No. of Toilets
19. Sapling Plantation and their survival No. of Plants
20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment
No. of Villages
21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages
No. of Villages
22. Blood Donation No. of Youth donated blood
23. Enrollment of Voluntary Blood Donors and their Blood Grouping
No. of Youth
24. Providing access of Iron Folic Acid Tablet to Adolescent Girls
No. of Adolescent Girls
25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.
No. of Girls
26. Motivate and Facilitated Institutionalized Deliveries
No. of Women
27. Immunization of Pregnant Mothers No. of Pregnant Mothers
S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved
No. of place/ village where progs. organized
No. of Days Name of collaborating agency / deptts.
Name & Designation of VIPs and dignitaries attended prog.**
Resource Mobilization Physical Number of Participants / Beneficiaries
Funds raised for activity ( in Rs.)
No. of Resource Persons, Trainers and Experts invited
Material, Equipments, Transport, etc.
Target (Annual)
Achieved SC ST Minority OBC Gen. Total
M F M F M F M F M F M F
28. Motivate and Immunization of Children (0-5 yrs)
No. of Children
29. Cataract (Eye) operations No. of Persons
30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)
No. of Camps
31. Enrollment of children in schools No. of Children
32. Beti Bachao - Beti Padhao Number
33. Facilitating into getting Voters ID Cards
No. of Persons
34. Training in Cashless Transaction to Youth Leaders
No. of Persons
35. Other Programmes as per local need and priority may please be added in the Plan with targets
** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct
Note : Please use the same proforma. Signature
Name:……………………………….
Prepared by Dealing Hand: Name & Signature ……………………………………… State Director with Office Stamp
Date ________________________ Date:………………………………..